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CPT 12001: Simple Repair of Superficial Wound, ≤2.5 cm

CPT code 12001 denotes the simple repair of superficial wounds 2.5 cm or less in length for body regions including the scalp, neck, axillae, external genitalia, trunk, and extremities (including hands and feet). This code defines a common, low-complexity procedural service performed in acute and ambulatory settings and is frequently used for initial management of uncomplicated lacerations. Nationally, clear coding for small superficial repairs affects claims accuracy, appropriate reimbursement, and audit risk for ambulatory and emergency providers.

Key payers represented in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a concise explanation of the clinical scope of the code, guidance on typical sites of service, and pointers to related CPT codes for larger simple repairs. The publication outlines common clinical indications and the ICD-10 diagnoses typically associated with these encounters, and it highlights which related CPT entries correspond to larger wound lengths for correct code selection. This summary supports billing staff, clinicians, and compliance teams seeking a clear national-level reference for coding superficial wound repairs with CPT code 12001.

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Billing Code Overview

CPT code 12001 describes the simple repair of superficial wounds measuring 2.5 cm or less. The service covers superficial laceration repair to the scalp, neck, axillae, external genitalia, trunk, and extremities (including hands and feet).

Service Type: Simple wound repair (superficial)

Typical Site of Service: Emergency department, urgent care, outpatient clinic, or physician office

National Reimbursement Benchmarks

Medicare's mean reimbursement for CPT 12001 sits at $117.7, which is modestly lower than BUCA's average commercial mean of $192.5. This gap of $74.8 highlights a significant commercial premium versus the federal program, with Medicare concentrated in a narrow middle band (P25 $110 to P75 $123) reflecting relatively stable, locality-driven payments.

Examining dispersion across payers using the interquartile range (P75 minus P25) shows variation in distribution tightness: Blue Cross Blue Shield has a wide IQR of $104 (P75 $306.1 minus P25 $202.1), indicating substantial variability in commercial contracts, while Aetna's IQR is $86 (P75 $129.9 minus P25 $41.3). UnitedHealth Group's IQR is $83 (P75 $170.5 minus P25 $82.7), Cigna's IQR is $97 (P75 $163.9 minus P25 $68.0), and BUCA's IQR is $93 (P75 $241.2 minus P25 $142.9), placing Blue Cross Blue Shield as the most dispersed and UnitedHealth Group as the tightest among these payers.

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CPT 12001: Simple Repair of Superficial Wound, ≤2.5 cm

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Billing Code Overview

Service Type: Simple wound repair (superficial)

Typical Site of Service: Emergency department, urgent care, outpatient clinic, or physician office

National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

A 28-year-old male presents to the emergency department after striking his head on a low beam while moving a ladder. He has a 2.0 cm superficial laceration to the scalp without evidence of a retained foreign body. After triage and wound assessment, local anesthesia is administered, the wound is irrigated, hemostasis is achieved, and a simple layered closure with interrupted sutures is performed. The procedure is documented as a simple repair of a superficial wound of the scalp measuring 2.0 cm, consistent with CPT 12001. The patient is discharged with wound care instructions and scheduled for suture removal in 7 days.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the same day of procedure	Use when a distinct E/M visit is performed in addition to the wound repair (e.g., history, exam, decision-making beyond the wound repair)

| 59 | Distinct procedural service | Use when the repair is a distinct service from another procedure performed the same day on a separate anatomical site

| 76 | Repeat procedure or service by same physician | Use when the same simple repair is repeated later the same day

| 52 | Reduced services | Use when the repair is partially reduced due to patient factors or intraoperative findings

| 53 | Discontinued procedure | Use when the planned repair is started but discontinued for clinical reasons

| GA | Waiver of liability statement on file (note: listed as AG in input) | Use when a voluntary ABN-like waiver is documented for non-covered service or when payer-specific waiver is required

| LT | Left side | Use to indicate the repair was performed on the left anatomical side when laterality is required by payer

| RT | Right side | Use to indicate the repair was performed on the right anatomical side when laterality is required by payer

| CG | Service furnished by an assistant at surgery (distinct contractor reporting) | Use when an assistant-at-surgery from a particular contractor taxonomy is billed

| 50 | Bilateral procedure | Not typically used for single wound repairs but available if a bilateral pair of separate wounds were repaired and payer requires this modifier

Taxonomy Code	Specialty	Notes
`208600000X`	Surgery Physician	General and specialized surgeons who may perform simple wound repairs in operative or outpatient settings

| 207Q00000X | Family Medicine Physician | Primary care physicians providing acute wound management and simple repairs in office settings

| 207P00000X | Emergency Medicine Physician | Emergency clinicians who commonly perform simple laceration repairs in the ED or urgent care setting

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S01.01XA`	Laceration without foreign body of scalp, initial encounter	Direct indication for a simple scalp wound repair coded with `12001` when wound measures ≤ 2.5 cm

| S51.81XA | Laceration without foreign body of right forearm, initial encounter | Forearm laceration that may be repaired with simple wound closure if superficial and ≤ 2.5 cm

| S61.219A | Laceration without foreign body of unspecified finger without damage to nail, initial encounter | Finger laceration appropriate for simple repair when superficial and within size limits

| S91.311A | Laceration without foreign body of right foot, initial encounter | Foot laceration that can be managed with a simple repair when superficial and ≤ 2.5 cm

| S41.011A | Laceration without foreign body of right shoulder, initial encounter | Shoulder laceration appropriate for simple closure if superficial and within the size threshold

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`12002`	Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.6 cm to 7.5 cm	Use when the simple wound length falls between 2.6 cm and 7.5 cm instead of `12001`

| 12006 | Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 7.6 cm to 12.5 cm | Use when the simple wound length is between 7.6 cm and 12.5 cm and exceeds the size limit for 12001

CPT 12002: Simple Repair of Superficial Wounds 2.6–7.5 cm

CPT-12004-SIMPLE-REPAIR-SUPERFICIAL-WOUND-7-6-12-5-CM

CPT 12004: Simple Repair of Superficial Wounds, 7.6–12.5 cm

CPT-12005-SIMPLE-REPAIR-SUPERFICIAL-WOUND-12-6-TO-20CM

CPT 12005: Simple Repair of Superficial Wound 12.6–20.0 cm

CPT-12006-SIMPLE-REPAIR-SUPERFICIAL-WOUNDS-20-1-30-CM

CPT 12006: Simple Repair of Superficial Wounds, 20.1–30.0 cm

CPT-12007-SIMPLE-REPAIR-SUPERFICIAL-WOUNDS-OVER-30CM

CPT 12007: Simple Repair of Superficial Wounds Over 30.0 cm

CPT-12011-SIMPLE-REPAIR-SUPERFICIAL-FACIAL-WOUND-2-5CM-OR-LESS

CPT 12011: Simple Repair of Superficial Facial and Mucous Membrane Wounds

CPT-12013-SIMPLE-REPAIR-SUPERFICIAL-WOUNDS-FACE-2-6-5-0-CM

CPT 12013: Simple Repair of Superficial Facial and Mucosal Wounds

CPT-12014-SIMPLE-REPAIR-SUPERFICIAL-WOUNDS-FACE-5-1-7-5-CM

CPT 12014: Simple Repair of Superficial Wounds of Face and Mucous Membranes, 5.1–7.5 cm

CPT-12015-SIMPLE-REPAIR-SUPERFICIAL-WOUNDS-FACE-76-125-CM

CPT 12015: Simple Repair of Superficial Facial Wounds, 7.6–12.5 cm

CPT-12016-SIMPLE-REPAIR-SUPERFICIAL-WOUNDS-FACE-12-6-20-CM

CPT 12016: Simple Repair of Superficial Facial and Mucosal Wounds, 12.6–20.0 cm

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References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the same day of procedure	Use when a distinct E/M visit is performed in addition to the wound repair (e.g., history, exam, decision-making beyond the wound repair)